title: The feasibility of nurse practitioner-performed, telementored lung telesonography with remote physician guidance - 'a remote virtual mentor'.
abstract: BACKGROUND
  Point-of-care ultrasound (POC-US) use is increasingly common as equipment costs decrease and availability increases. Despite the utility of POC-US in trained hands, there are many situations wherein patients could benefit from the added safety of POC-US guidance, yet trained users are unavailable. We therefore hypothesized that currently available and economic 'off-the-shelf' technologies could facilitate remote mentoring of a nurse practitioner (NP) to assess for recurrent pneumothoraces (PTXs) after chest tube removal.
  
  
  METHODS
  The simple remote telementored ultrasound system consisted of a handheld ultrasound machine, head-mounted video camera, microphone, and software on a laptop computer. The video output of the handheld ultrasound machine and a macroscopic view of the NP's hands were displayed to a remote trauma surgeon mentor. The mentor instructed the NP on probe position and US machine settings and provided real-time guidance and image interpretation via encrypted video conferencing software using an Internet service provider. Thirteen pleural exams after chest tube removal were conducted.
  
  
  RESULTS
  Thirteen patients (26 lung fields) were examined. The remote exam was possible in all cases with good connectivity including one trans-Atlantic interpretation. Compared to the subsequent upright chest radiograph, there were 4 true-positive remotely diagnosed PTXs, 2 false-negative diagnoses, and 20 true-negative diagnoses for 66% sensitivity, 100% specificity, and 92% accuracy for remotely guided chest examination.
  
  
  CONCLUSIONS
  Remotely guiding a NP to perform thoracic ultrasound examinations after tube thoracostomy removal can be simply and effectively performed over encrypted commercial software using low-cost hardware. As informatics constantly improves, mentored remote examinations may further empower clinical care providers in austere settings.
authors.affiliation: Regional Trauma Services, Foothills Medical Centre, Calgary, Alberta T2N 2T9, Canada. andrew.kirkpatrick@albertahealthservices.ca.
authors.forename: Nancy
authors.initials: N
authors.lastname: Biegler
authors.forename: Paul B
authors.initials: PB
authors.lastname: McBeth
authors.forename: Corina
authors.initials: C
authors.lastname: Tiruta
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Hamilton
authors.forename: Zhengwen
authors.initials: Z
authors.lastname: Xiao
authors.forename: Innes
authors.initials: I
authors.lastname: Crawford
authors.forename: Martha
authors.initials: M
authors.lastname: Tevez-Molina
authors.forename: Nat
authors.initials: N
authors.lastname: Miletic
authors.forename: Chad G
authors.initials: CG
authors.lastname: Ball
authors.forename: Linping
authors.initials: L
authors.lastname: Pian
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Kirkpatrick